Willpower Incorporated - Taking Care of Quartzsite
Print this form, fill in the required information & mail it to:
Willpower, Inc., Box 3035, Quartzsite, AZ 85359
Phone (928) 916-0657
| Membership levels | Please print: |
|
| _____ | $5,000 Platinum | ______________________________________________ Name |
| —— | $1,000 Gold | _________________________________________ Address |
| —— | $500 Silver | _________________________________________ City |
| —— | $250 Copper | _________________________________________ State, Zip |
| —— | $150 Lifetime | (__________)______________________________ Phone |
| —— | $50 Kind Donor | __________________________________________ |
| —— | $10 Individual - annual fee | __________________________________________ Web site |
I am interested in supporting
_____ Paw Power _____ Q A C
_____ Willpower General Operating Funds
Please make checks payable to Willpower Incorporated and mail to Box 3035, Quartzsite, AZ 85359